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Sensitivity to Fiber, Sugar and Fats

Question:

My son is 4 years old. We realized he has celiac disease when he was 2 and screamed every time he had a bowel movement. We now live gluten-free, but I’m wondering why even after 2 years he is still very sensitive to fiber - like nuts, oats and corn. He also eats dairy-free. If he has "too much fiber" or even too much sugar or fat, he gets pains in his rectum when trying to sleep at night. They are like a muscle spasm that you can feel if you apply pressure to his bottom. Heat seems to help, but I’m feeling like there must be something else going on. My family doctor suggested that it’s probably "something he’ll grow out of." Are other children with celiac also sensitive to fiber, sugar and fats?

From,

Amber

Answer:

Dear Amber,

As you know, in celiac disease, the immune system reacts against gluten and causes damage to the small intestine. In particular, the villi of the small intestine are flattened.  Villi are finger-like projections on the inside of the bowel which function to digest and absorb nutrients. When the villi are damaged, this causes malabsorption of all sorts of nutrients – including carbohydrates and fats. 

Many children with celiac disease are sensitive to carbohydrates and fats initially. However, the villi heal (in a matter of months) once there is no longer exposure to gluten. In other words, when there is strict adherence to a gluten-free diet, the sensitivity should resolve.

There are certainly other disorders in children that cause malabsorption or sensitivity to nutrients or specific foods. Examples of these disorders include food allergy and inflammatory disorders such as Crohn’s disease. I would recommend that you discuss these possibilities with your doctor.

Finally, pain in the rectum is not a symptom which we typically see with celiac disease, and it should be evaluated.  I would recommend a visit with and a good physical examination by a pediatric gastroenterologist.

Sincerely,

Center for Celiac Disease at The Children's Hospital of Philadelphia 

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